Tie Congress’s Paychecks to Our Good Health

Dark clouds hovered over the Capitol on Tuesday as Senate Republicans postponed a vote on their health care bill.CreditCreditMark Wilson/Getty Images

Members of Congress are paid $174,000 a year, while members of Poland’s lower house of Parliament are paid $32,300 a year.

Hmm. It looks as if we’re getting ripped off. Members of Congress seem to underperform compared to members of Parliament in Poland and across the democratic world.

Conservatives are right to worry that feeding at the government trough breeds dependency and laziness. So I suggest we introduce pay for performance, using metrics like, say, health.

I cite Poland because so many Poles (including the Krzysztofowicz family, later renamed Kristof) came to America for a better life, yet today American babies are one-third more likely to die in their first year of life than Polish children are (and twice as likely as Italian, Portuguese and Czech babies!). Meanwhile, American women are four times as likely to die in pregnancy and childbirth as Polish women, according to the World Health Organization.

If we had Italy’s child mortality rate, we would save 12,000 American babies’ lives each year — that’s 33 children’s lives saved every day.

Meanwhile, the U.S. spends far more on health care — an average of nearly $10,000 per person — than other countries do. Poland spends just $1,680 per person.

This is a stain on America. Choose almost any modern country, and its people pay less for health care and its children are more likely to survive; the C.I.A.’s World Factbook ranks the U.S. 42nd in longevity, and we’ve had a smaller increase in life expectancy over 25 years than other industrialized countries have.

In short, we as taxpayers are getting cheated. Should we really be paying senators a base rate of $174,000 — Mitch McConnell as Senate majority leader gets more — to preside over such bad results?

It’s time to apply the discipline of markets. For the sake of our senators’ own characters, we should pay for work.

If we now pay almost six times as much per capita on health care as Poles do, and get outcomes that are far worse, hmm, what do you think? Maybe we pay our representatives one-tenth what the Poles get? That would be $3,200 a year for a member of Congress.

Good thing Congress has resisted raising the minimum wage!

O.K., I’m not really in favor of slashing congressional pay; we should pay officials well to attract the best talent.

But I offer this absurd proposal for two reasons. First, many Americans, including politicians, just don’t understand how poorly our health care system actually performs by international standards.

It’s true that American hospitals have the finest diagnostic equipment and the best specialists, but we falter at basics and at public health. We’re lousy at getting kids vaccinated, at reaching at-risk young people with contraception, at protecting citizens from lead and endocrine-disrupting chemicals — and simply at keeping people alive.

That leads to my second point: We need universal health care.

In Poland, Canada, Britain and virtually every other advanced democracy, there is a national health system, with single-payer coverage like Medicare for all.

Analysts find that Canada’s rollout of single-payer coverage cut infant mortality by 5 percent. Likewise, researchers have found that cystic fibrosis patients live 10 years longer in Canada than in the U.S., because of insurance gaps in America.

Granted, there are deep underlying problems in the U.S. that complicate health care. Inequality is immense, obesity is widespread and American teenagers have babies at several times the rate of European teens.

But one reason to think that universal health coverage would make a difference is that when Americans make it to age 65 — after they get Medicare — life expectancy of 18 more years for men and 20 more for women is roughly the same as in Europe. When Americans finally get single-payer care, we do fine.

Likewise, a new study in Annals of Internal Medicine finds that in the U.S., being insured significantly reduces death rates for young and middle-aged people.

All health care reform efforts — whether Obamacare or Trumpcare — struggle with the unwieldiness and inefficiency of the existing architecture, built on employer-provided coverage. The basic problem is that we’re spending almost $10,000 per person per year on health care, and somebody has to pay for it or else we ration care and people die.

Early research finds that Obamacare is helping: One study finds it saving the life of one millennial a day.

But ultimately the United States should follow the example of every other advanced country and ensure health coverage for all. “We’re going to have insurance for everybody,” President Trump promised a week before taking office. Now he backs plans that would lead to 22 million fewer people having coverage. But if Taiwan, Slovenia, Spain, Japan and just about every other modern country can have coverage for everyone, so can we.

And, members of Congress, here’s the deal: If you ever adopt Medicare for all, I’ll endorse a pay-for-performance pay raise for all of you along with guaranteed, subsidized health insurance.